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Community Health

Community Health. What is it? Why should I care?. Definition of Community Pediatrics Adapted from Robert J. Haggerty, MD. The unique feature of community pediatrics is its concern FOR THE ENTIRE POPULATION OF CHILDREN

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Community Health

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  1. Community Health • What is it? • Why should I care?

  2. Definition of Community Pediatrics Adapted from Robert J. Haggerty, MD • The unique feature of community pediatrics is its concern FOR THE ENTIRE POPULATION OF CHILDREN • Community pediatrics [seeks] to provide a more realistic and complete clinical picture by: • taking responsibility for all children in a community, • understanding the determinants and consequences of child health and illness, • providing preventive and curative services, • understanding the effectiveness of services provided.

  3. What is Health?

  4. Ecological Model

  5. Why leave the office? • Sitting in the office or hospital we miss: • Many high risk children • Many opportunities to prevent illness • Many opportunities to promote good health

  6. Why leave the office?Adapted from Judy Palfrey MD • Pediatricians bring important skills to the table • Developmental perspective • Concept of differential diagnosis • Notion of normal variation • Prevention strategies and orientation • Tailored/Individualized Approach • Continuity

  7. Who is our ‘community’? • New York City? • Washington Heights and Inwood? • The Dominican Community? • Medicaid patients? • Children who have ever come to CPMC?

  8. Population perspectiveTaking responsibility for all children in the community • Determinants of Health • Poverty is the single most important factor influencing health and disease at the population level • Race effects health outcomes independently of poverty http://www4.nationalacademies.org/onpi/webextra.nsf/web/minority?OpenDocument

  9. Relationship of income to injury rates - Northern Manhattan • Injury rates higher in largely low income census tracts compared to census tracts with fewer low-income households- • Relative Risk 4x for assault and gun shot injury • Relative risk 2x for unintentional injuries

  10. Disparities in Child Health • What are the mechanisms for poverty causing increased child morbidity and mortality? • Why are Infant Mortality rates higher in poor communities?

  11. Disparities in child Health • IOM: ‘Unequal Treatment” Health Disparities: ….”racial or ethnic differences in quality of health care not due to access, clinical needs, prferences and apropiateness of intervention”

  12. Root causes disparities • Individual (child/parent/family): health beliefs, parental health, educational status, • Health Systems (family, provider, local, National): SES, Cult comp, access, quality of care, medical technology • Community (neighborhood, local government): SES, violence, social capital • Societal: racism Ref: Horn and Beal

  13. Latino paradox • Many studies link poverty to poor health • Latinos are poorer than African Americans but have lower overall mortality rates, death from cancer and heart disease, infant mortality than AAs/ whites • But--acculturation leads to poorer health outcomes

  14. Latino paradox • What causes the paradox? Theories: • “Healthy immigrant”; • Strong social/family networks • Low tobacco and ETOH use especially in women • Religiosity • Traditional healing practices • Traditional diet

  15. Maternal and Child Health • Mother’s health effects her child’s health • Prematurity/Pregnancy outcomes • Depression • Smoking • Substance abuse • Parental availability (long work hours) • Child Development (e.g. literacy) • Child’s environment depends on mother’s resources

  16. Maternal and Child Health • Potential Pediatrician impact on maternal health • Screen and refer for DV, depression • Child Spacing/family planning • Smoking • Developmental support for child • Expand horizons/knowledge of resources • Advocacy for better maternal health services

  17. Community wide efforts can have a big impact • Programs that mitigate the effect of poverty have the potential to improve health • Medicaid • Child Health Plus • Supplemental Social Security (SSI) • WIC • Head Start

  18. Community wide efforts can have a big impact • Legislative efforts • make window guards the landlords responsibility, • package aspirin in small bottles, • require seat belt use and speed limits, • require vaccination for school entry

  19. Community wide efforts can have a big impact • Results • Window guard legislation • Deaths fell by 50% in 2 years • Aspirin packaging • Ingestion rates fell by 50% in 2 years • Seat Belt laws enforced • Fatality rates dropped 20% vs. 8% in control states • Speed limit • Fatalities rose 19% in states that raised limit to 65 MPH (1987)

  20. Working with others, one MD can make a difference

  21. Community wide efforts can have a big impact • Communities can mobilize resources to: • Make schools better • Create after school or sports programs, • Make quality child care available • Rebuild community institutions after a disaster

  22. Pediatricians Role • Physicians have a powerful voice • at the community • at the legislative level • We have an obligation to use that voice to improve health of children

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